Gum disease

What is gum disease?

Gum disease is a gradual process that starts with the build up of plaque on teeth and then develops over time.

Plaque is a mixture of food and bacteria that accumulates on your teeth after eating.

If this is not removed by brushing, it starts to irritate and inflame the gums (gingivae). Inflammation of the gums is known as gingivitis.

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When gingivitis is left untreated, the gums begin to recede from the teeth. This starts to leave a tiny 'pocket' at the base of the tooth that becomes increasingly difficult to brush properly.

Any plaque here that isn't removed then slowly starts to harden to something called tartar or calculus. If this tartar continues to build up, then further irritation and inflammation around the gum occurs.

Advanced gum disease (periodontitis)

As tartar builds, the inflammation slowly begins to affect the bones around the teeth. The pockets get deeper and eventually some of the tooth root itself may be visible.

Dentists call this chronic periodontitis and it causes the teeth to loosen to the point where they may fall out or need to be taken out by a dentist.

How common is gum disease?

Gum disease is extremely common. It can happen at any age, although it's rare for it to occur to a significant degree in children.

What are the symptoms?

Many people with gum disease are unaware they have a problem because it's often 'silent' with no pain or symptoms.

Otherwise, the first sign is usually bleeding from your gums when you brush your teeth.

Gums may also become swollen, red and uncomfortable.

You may have bad breath.

There may be an unpleasant taste in the mouth.

More advanced gum disease can lead to loosening of the teeth or even abscesses in the gum.

Who is most at risk?

Although anyone can get gum disease, it's more likely in people who don't clean their teeth regularly or those who find it difficult to clean their teeth properly.

Braces, dentures and irregularities in tooth shape or spacing can all make it difficult to reach an area with a toothbrush.

Other risk factors include smoking, diabetes and occasionally pregnancy.

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What is the treatment for gum disease?

Gum disease always requires treatment by a dentist or dental hygienist. There are various types of treatment available depending on the severity of gum disease.

Simple gingivitis usually requires your dentist or hygienist to thoroughly clean and de-scale teeth using a special electric scaler, electric toothbrush and gritty toothpaste.

Your dentist may also recommend using:

antiseptic mouthwash, such as chlorhexidine, to help reduce the formation of plaque in the future

an electric toothbrush because tests have shown that those with an oscillating-rotating action (head rotates back and forth) remove more plaque than manual ones.

Periodontitis

If you have periodontitis, more extensive de-scaling is needed to remove plaque and tartar from the gum pockets that have formed. This may need to be done over a number of appointments rather than one.

Although scaling procedures are simple, they can be uncomfortable. Some dentists may numb your gums beforehand with local anaesthetic, either as an injection or a cream.

After scaling, follow-up involves monitoring the size of the gum pockets over several months to make sure the gum disease is not getting worse.

Very advanced gum disease can cause gum pockets that are too deep for treatment by simple scaling. In these cases, gum surgery is needed, where the gum is peeled back to allow access to the diseased area so tartar can be cleaned.

Gum surgery is performed by a periodontist – a dentist who specialises in treating periodontitis.

They are trained in performing more extensive and deeper scaling, along with any other treatment needed.

Your dentist will refer you to a periodontist, if necessary.

How can I prevent gum disease?

You can prevent gum disease by keeping the amount of plaque and tartar that builds up on the teeth to a minimum.

The following will help keep teeth and gums healthy.

Brush your teeth for two minutes last thing at night and on on at least one other occasion again.

Clean in-between teeth at least once daily with interdental brushes or dental floss

Change your toothbrush or brush head every three months.

Don't smoke.

Visit your dentist every six to 12 months.

You can improve the removal of plaque with a correct brushing technique, for example by using circular movements and making sure you brush the gum line above teeth.

Your dental hygienist can show you how to brush, and also how to use floss and interdental brushes to remove plaque and food debris from places toothbrushes can't reach.

Even thorough dental hygiene can't remove every trace of plaque, so you may find some scale removal at the dentists is always needed. This is not necessarily abnormal.

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